OCHO RIOS, St Ann:THE TRUE essence of Jamaicans living abroad continues to shine across the miles to their beloved island as yet another overseas-based group has started an organisation to help children in Jamaica.

In January 2013, Stephen Martin, assisted by Orenthia Ricketts, started The Hands For Giving Foundation in New Jersey, USA, primarily to assist kids in basic schools in Jamaica.

Last week, Martin was in Jamaica for seven days, bringing joy to students at Buxton and Discovery Bay basic schools in St Ann and Duanvale Basic School in Trelawny.

"We are determined and energised to make a difference in basic schools across the island," Martin told Rural Xpress last Friday.

"We have outfitted three schools with book bags, school supplies and teaching materials. Those schools are Buxton, Discovery Bay and Duanvale basic schools. The children were also surprised with treats and snacks. The kids were really receptive and the teachers were happy that someone remembered that they are there."

Martin bemoaned the poor state of some of the basic schools, some of which are without electricity and or piped water. But this has made him and his team more determined than ever to assist.

"It's really just the need, that's why we do it. After visiting the island for many years, we saw the need and we really want to help; we want to make changes; we want to impact the whole island.

"What we found was that it was very challenging to try to help the older people or to make changes for the older folks, so what we did was we decided we're going to target basic schools so we can curve the tree when it's young. So if we can encourage or pull one person out of poverty through education, it would really make a big difference."

Hands For Giving is not seeking to work alone. The organisation is hoping to collaborate with service clubs such as Kiwanis and Rotary to continue helping the kids.

Martin migrated from Jamaica several years ago after graduating from Knox College and CAST College of Arts, Science and Technology, now University of Technology, Jamaica.

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Penda Honeyghan reads to children from Craig Town, Kingston who are participating in mentor ship programme managed by students of the AZ Preston Hall at University of the West Indies. Sixty children were murdered and 99 shot and injured by criminals between January 2013 and May 2014, according to the latest data from the Jamaica Constabulary Force (JCF) Statistics Department.Police report that, in the last two months alone, seven children between the ages of 7seven and 17 years were murdered, while one was shot and injured. The Police High Command, in response to the brutal attacks has issued a call on all Jamaicans to redouble their efforts to safeguard the nation’s youth.

The police said they were also concerned about the number of youths becoming involved in gun-related crimes, citing statistics to show that, for the period January 1, 2013 to May 25, 2014, some 44 children were charged with murder, 40 with shooting and 94 with breaches of the Firearms Act. “Police intelligence suggests that gangs continue to co-opt children in their criminal organizations to commit crimes," the Police High Command reported.

"Children are routinely found to be armed with weapons of all kinds — knives, machetes, even cleverly made home-made firearms, which are believed to be supplied by criminal gangs," the police said. While the police continue to enforce the law and employ policing strategies to dissuade young people from a life of crime, parents, caregivers and communities were being urged to care for children and to seek the assistance of the police, the Child Development Agency, or other appropriate authorities where necessary. The Plolice also urged citizens to report any abuse of children or their involvement in crimes.

"Children are too precious a resource for well-thinking Jamaicans to stand by and do nothing to help them. Now more than ever, Jamaicans must unite for change; it is our civic duty to care for and protect our children," the police said.

Policymakers are confronted on a daily basis with an enormous list of priorities. From improving the status of women, to mitigating climate change and infrastructure development, many worthy activities are competing for limited resources. It is in this context that we argue: investing in the reduction of chronic undernutrition in very young children is not just worthy, it's sound economics.

The economic rationale for investments that reduce undernutrition is simple: weigh the costs against the benefits. The catch in this, of course, is exactly how you calculate each side.

A second group relates to economic gains that arise because better nourished children are taller in adulthood and have better cognitive skills. For example, undernourished children score poorly on tests of attention, fluency and working memory all of which affect success at school. In turn, taller individuals with better cognitive skills are more economically productive. Some benefits are intergenerational – for example, women who are better nourished as children complete more schooling and are consequently less likely to have undernourished children themselves.

And all these gains could be possible at low cost. Recent research has established a package of interventions, costing around $100, that when implemented together would reduce the prevalence of undernutrition by 20%. The package would include interventions aimed at:

3. Reducing the impact of infections

Infections often contribute to undernutrition. Energy that should be used for growth is instead diverted to fight off infections and the infections themselves often diminish appetite and thus energy intake. Providing each person with therapeutic zinc supplementation can help to mitigate against the effects of infections, including diarrheal disease, and therefore prevent undernutrition.

4. Improving nutritional knowledge

Children are more likely to be well-nourished if their mothers know which foods are nutritious and understand how their offspring benefit from consuming them. In environments characterised by food insecurity, community-based programmes that provide information on nutrition, breastfeeding and complementary feeding work well to ensure this.

Using these methods, we find that the economic benefits far exceed the economic costs of investing in the reduction of undernutrition in the 17 countries which collectively account for much of the global prevalence of stunting. For example, in Bangladesh, every dollar invested in reducing chronic undernutrition generates around $18 in economic returns. Using the standards by which public expenditure is measured, these are enormously high returns. As policymakers grapple with multiple priorities, trying to weigh up the costs and benefits of each, it is clear that investing in reducing undernutrition is in fact really good economics.

There has been much recent discourse on 'scaling up' in nutrition, but what do we mean by it? In response to the sobering words of the first Lancet Nutrition Series in 2008, which described the international nutrition system as "fragmented and dysfunctional," the Scaling Up Nutrition (Sun) movement is now driving the global momentum.

Forty five countries (which include nearly 60% of the world's stunted children) have now signed up to the Sun movement – the glaring exception is India, home to over one third of the world's stunted children. In London last June, the Nutrition for Growth summit made history by generating over $23bn (£14bn) in pledges to tackle undernutrition (over $4bn for nutrition-specific and $19bn for nutrition-sensitive interventions).

The Sun movement and Nutrition for Growth have both made progress on the issue, but if 2014 is to be the year when significant numbers of children receive better nutrition then we need to understand how to reach more children. We need clear strategies, to learn from the past, and assess capacity.

While most focus on quantitative aspects of scaling, we cannot forget quality. In the late 1990s, India rushed to universalise its main nutrition programme, the integrated child development scheme, to cover all its districts – and yet there was little change in malnutrition levels in the years that followed. Boxes may have been ticked, but many villages didn't have the means to implement the scheme.

The state of Maharashtra (which recently joined Sun, despite India's decision not to) has since shown what is possible. Responding to reports of a wave of child deaths from starvation in marginalised tribal districts despite a state-wide economic boom, a nutrition mission was launched. The mission focused on strengthening implementation of existing programmes. Ensuring that existing vacancies were filled and frontline workers were supported by systems of training, supervision and monitoring (aimed at motivating, not policing) paid huge dividends. The frequency and quality of interaction between community workers and mothers improved enormously, and the rate of stunting decline between 2005 and 2012 was more than quadruple that of 1999 to 2005.

A generation before, a similar approach in Thailand underpinned its great leap forward, when child undernutrition rates plummeted during the 1980s. The breakthrough here came with the use of basic minimum needs indicators for community and district planning by teams of community leaders, nutrition and health professionals, mid-level government officials, representatives from NGOs and district chiefs of various sectors. Based on the problems revealed by these indicators, a 'menu' of nutrition-relevant actions was developed and implemented. A key factor in the project's success was a manageable ratio of community-level mobilisers and district-level facilitators. Wider collaboration between health, agriculture, education and rural development sectors supported these community initiatives. Lessons from successful projects like this are relevant today.

Too many strategy discussions start by asking how we expand the intervention. Instead, the starting point should be a vision of what success looks like, and what constitutes impact. Achieving that vision may require different routes. In an influential paper in 2000 Peter Uvin delineated four key pathways to reach large-scale impact (in this case of NGO activities):

a) Quantitative ( or 'scaling out') in which the coverage of an intervention increases.

b) Functional, in which horizontal (cross-sectoral) or vertical (national to local) linkages are made.

c) Organisational, in which capacities of organisations are strengthened.

d) Political, which reflects a move towards progressive empowerment of communities to make demands and national leaders' being held accountable for public action.

Due to its multi-sectoral nature, most of these pathways will need to be pursued to achieve wider impact on nutrition.

But there are no simple solutions. With a new set of international development goals on the horizon, we should look back on this year as the watershed for nutrition – when the grand words and pledges of past high-level summits get turned into large-scale action, millions of children get healthy fulfilling lives.

This week I am called to see Faraja, a four-year-old girl with SAM. She is weak from a combination of starvation and infection, and cannot swallow without food going into her lungs. I inject antibiotics and place a tube through her nose to drip milk into her stomach. It is a precarious balance between giving enough to prevent fatally low blood sugar, and avoiding stressing her fragile metabolism and undernourished heart. Two days later, despite regular feeding, the infection is overpowering. I give CPR. It is a formality. Faraja's file joins a pile of three others on my desk, all children lost to malnutrition this month.

Faraja had more chance than most, arriving when therapeutic foods are in stock. The World Health Organisation recommends two pharmaceutically prepared formula milks, F75 and F100. These contain a combination of powdered cow's milk, sugar, fat and micronutrients, specifically proportioned for a starving child's metabolism. By adding clean water you have most of what is needed to treat malnutrition. It is liquid, allowing us to give by tube to semi-conscious children like Faraja. The disadvantages are cost, and reliance on a supply chain. Within Tanzania, it is only available through UN agencies and NGOs.

Our three boxes of formula milk will soon run out, with no guarantee of replacement. We contacted the UN for assistance after seeing numbers of children admitted with SAM double in 2013, and then double again this year after floods destroyed crops and infrastructure.

Unicef runs a programme supporting treatment of SAM in our region, and the NGO prompted our regional hospital to supply us with therapeutic milk. We were told only three boxes could be spared. This is enough to treat two or three children for the six to eight weeks required to recover from SAM. This week alone we admitted two new cases.

Admittedly, the need is huge, and formula milk is not a sustainable solution in a country where nearly 2% of under-fives are severely malnourished. But it can help some, and failures of the government and UN agencies to distribute scarce resources appropriately are frustrating. When I visited the storeroom of the regional hospital to collect our supply, I noticed several unopened boxes which expired last year.

Most often, we use a more expensive alternative, mixing powdered milk with sunflower oil, sugar and water to approximate the pharmaceutically prepared formula milks. The ingredients require careful weighing by a nurse caring for a ward full of sick children. Errors are frequently made. Furthermore, we must find micronutrients to enrich the foods. A ready-mixed micronutrient powder is available, but only along the same supply chain as the pharmaceutically prepared milks. We substitute this with vitamin and mineral tablets. Some, like zinc, are easily found due to its widespread use to treat diarrhoea, but we cannot find the more obscure elements, like selenium, copper and magnesium.

The World Food Programme, Reach and Scaling-up Nutrition are working with the Tanzanian government to improve nutrition. There are good evidence-based policies to move treatment of stable children with uncomplicated SAM into the community, and feed with locally available foods. But there is little mention of how we should feed children with complicated SAM, like Faraja. They arrive unconscious, sometimes hours from death. Hospital treatment with easily prepared formula milk offers the best chance of survival. But where will this come from?

Ultimately, prevention is much more effective than cure. Feeding severe cases helps a few, it doesn't untangle the social and economic causes of malnutrition. The government and their partners will help many more by promoting breastfeeding, diversifying crops and fortifying food. But as a doctor the immediate concern is the person in front of you. For now, we will continue to make an imperfect difference trying to save children like Faraja.